Alcohol Abuse and Alcoholism

Alcohol abuse is the desire for alcohol even when there are alcohol-related work, legal, health, and family problems. Alcohol abuse can progress to alcohol dependence or alcoholism. Alcoholism is a condition in which a person becomes physically dependent on the effects of alcohol and drinks to avoid withdrawal symptoms.

It is estimated that nearly 17.6 million people in the United States abuse alcohol or are alcoholics. More men than women are alcohol dependent or have alcohol problems. Alcohol problems are highest among young adults, age 18 to 29, and lowest among adults age 65 and older.

It may not be easy for you to accept the fact that you need help for an alcohol problem . But keep in mind that the sooner you get help, the better your chances are for a successful recovery.

You may have concerns about discussing drinking-related problems with your doctor. This may stem from common misconceptions about alcoholism and people who have alcoholism. In our society, some people may perceive alcohol problems as a sign of moral weakness. As a result, you may feel that to seek help is to admit some type of shameful defect in yourself. However, taking steps to identify a possible drinking problem has an enormous payoff: a chance for a healthier, more rewarding life.

A diagnosis of alcohol abuse or alcoholism is often based on an initial assessment, physical examination, and psychological evaluation.

Initial Assessment

When you visit your doctor, she will ask you a number of questions about your alcohol use to determine whether you are having problems related to your drinking. Try to answer these questions as fully and honestly as you can. These are some of the questions you may be asked:

Have you tried to reduce your drinking?

Have you felt bad about your drinking?

Have you been annoyed by another person’s criticism of your drinking?

Do you drink in the morning to steady your nerves or cure a hangover?

Do you have problems with a job, your family, or the law?

Do you drive under the influence of alcohol?

Physical Examination and Tests

You also will be given a physical examination, which may include the following tests:

Blood tests to look at the size of your red blood cells and to check for a substance called carbohydrate-deficient transferrin (CDT), a measure of alcohol consumption

Blood tests to check for alcohol-related liver disease and other health problems, such as gamma-glutamyltransferase (GGT)

If your doctor concludes that you may be dependent on alcohol, she may recommend that you see a specialist in alcoholism. You should be involved in any referral decisions and have all treatment choices explained to you.

Psychological Evaluation

You may also be evaluated for psychiatric disorders that often occur with alcoholism, such as anxiety disorders and depression . You may be evaluated by your doctor or be referred to a mental health professional.

In his own words: living with alcoholism

As told to Virginia Mansfield

Rick* began drinking when he was 12 years old; he didn't realize it was a problem until his early twenties. As a son of an alcoholic mother and being an alcoholic himself, he felt angry, isolated, and constantly full of fear. Now, after 23 years of sobriety, he speaks openly and honestly about his alcoholism and recovery. He is married and has three daughters, ages 18, 16, and 10.

What was your first sign that something was wrong? What symptoms did you experience?

It's difficult to say exactly what was the first sign that something was wrong, because, if I'm honest—and in retrospect—I can say that there were signs right from the very start of my drinking: drinking for the effect, to get attention, to fill an emotional void, blacking out. But, at the time, I really wasn't aware that there was a problem. Drinking was something cool to do and I did it without questioning any of the consequences.

Probably the first time I really remember knowing that there was a problem with my drinking was in my early twenties. I never drank in moderation. One drink and I was off to the races. Often the first drink appeared to be totally innocent—just a beer between friends, or a shot of Russian vodka to "take the edge off," or a civilized glass of wine at an art opening—and before I even knew what was happening, I was drunk and doing crazy things.

A friend told me that maybe I was the kind of person who couldn't drink anything at all; it was the first time I can remember being cornered by the truth, with no way out. Cornered or not, as soon as he left I began to drink again and with each drink the sensitivity and truth of his statement drew further and further away, like a siren receding down a crowded street. Before long, there was nothing left of it to remember.

In terms of physical symptoms, I experienced blackouts almost from the very beginning of my drinking, at around age 12. Later, in my early twenties, I experienced the shakes, vomiting, dehydration, slurred speech, paranoid and irrational fears, and a lack of impulse control. I was angry, isolated, and full of fear. I wanted social interaction, but couldn't manage it once I'd had a few drinks. I felt alone and hopeless, unable to connect with people unless I had a few drinks and then doomed to alienate them by the time I'd had a few more. Essentially, I was unable to control my drinking—how much, when, where, how often—and once I'd taken the first drink, the compulsion to keep drinking kicked in.

What was the diagnosis experience like?

I am one who never was "officially" diagnosed—I never went to a treatment center or medical facility directly for my alcoholism. For the last few years of my drinking, I referred to myself as an alcoholic, though I didn't really comprehend what that meant. For me, it was a convenient way of justifying my drinking, like, "Why do you think I got drunk at the picnic...I'm an alcoholic, that's why."

I used the term to deflect criticism, in the sense of denigrating myself before anyone else got the chance to do so. That was basically my pattern—to put myself down before you got the opportunity. But I really didn't have a clue what it meant to be an alcoholic—the true meaning of the word. I had a picture of an alcoholic in my mind that was very romantic: the drunken poet, the staggering but brilliant artist, the sensitive writer. It wasn't until I got sober that I began to recognize the reality of what being an alcoholic meant: that I couldn't drink—even just a few beers—without negative consequences either physically, emotionally, or spiritually. After being sober nearly a year, I recognized in my heart for the first time that I was really sick, that I had an illness that was beyond my comprehension and ability to control. So my diagnosis was really a self-diagnosis, and it came once I had actually been sober for a while and was beginning to see the reality of my situation.

What was your initial and then longer-term reaction to the diagnosis?

In many respects, it was a relief to finally recognize the diagnosis. I had always thought that I was somehow "at fault" for my behavior, that it was a character failing that I couldn't control my drinking and that I did all the crazy things that came along with it. I felt like I was a bad person—a misfit, a reject. But when I finally came to recognize the alcoholism at work in my life—a power far greater than me—it was easier to accept myself with compassion and understanding instead of berating myself with contempt, disapproval, and judgment. It made it easier to recover.

In terms of my longer-term reaction, diagnosing myself as an alcoholic—and being in recovery—has given meaning and direction to my life. Through understanding that I have the disease of alcoholism and my commitment to recovery, I have a central purpose in my life—something I can really hold onto. It helps to define who I am, what has happened to me in my life, and what I need to do in the present. I am a recovering alcoholic, and I need to stay away from the first drink.

How do you manage the alcoholism?

I am one of the ones who was fortunate enough to walk into an Alcoholics Anonymous (AA) meeting—drunk at the time—and never pick up a drink again. AA provided an environment in which I could stay sober. It provided the tools to learn enough about myself and my alcoholism to stay away from the first drink. There was just the right mix of structure and anarchy in AA that allowed me to reach out for help in my own way and in my own time. Nobody pressured me or told me I had to do things in a certain way. They simply allowed me to be there with them, as they were getting sober, and I slowly began to learn about myself through the sharing of others.

There were many tools I heard about in the rooms of AA and began to use in my own life: the slogans were easy, cogent, and pertinent (easy does it, first things first, it's the first drink that gets you drunk, etc.), and the Twelve Steps had a practical application as I learned about powerlessness, unmanageability, and the need for a spiritual connection with a power greaterthan myself. For the first time in my life I had a sense of support and community—a group of people in my life who understood where I had been and where I was going.

From the very beginning, I managed my alcoholism by regular attendance at AA meetings and ongoing review of the Twelve Steps and other AA literature and materials. I also developed a very close friendship with another alcoholic, also in AA, which allowed us both to talk regularly about alcoholism and recovery and to share our individual experiences, our strengths, and ourhopes. Later, after a few years of sobriety, I attended group and, ultimately, individual therapy for about five years. I have always found therapy with an understanding practitioner to be helpful and have availed myself of this service at different times throughout my sobriety.

Did you have to make any lifestyle or dietary changes in response to the alcoholism?

Yes, plenty. In the beginning, it was very important to stay away from people, places, and things associated with my drinking. That meant I had to stay out of the bars and places where I used to drink, had to distance myself from the people I used to drink with, and had to change a lot of my routines—often things as seemingly innocent as walking down a different block so that I wouldn't have to pass by the liquor store where I used to buy my liquor or the grocery store where I used to buy beer. Instead, I went to AA meetings, where I slowly began to meet new people—people who were trying to stay sober, too. There weren't too many people at the end of my drinking who really cared about me—there were acquaintances and people in bars who I drank with, but nobody who particularly missed me once I stopped hanging around and started spending my time in AA meetings. Most of the people I knew were ultimately glad when they heard I was going to AA.

Slowly, I had to learn a whole new way of doing things. Alcohol had been so much a part of my life that it touched on every aspect of my existence. Just about everything I had done in my life, I had done with a drink: sex, relationships, school, work, creativity, paying the bills, even simple conversations were somehow rooted in alcohol. I used alcohol to manage my life—unsuccessfully, of course—and I had no other frame of reference. I had to learn new ways of doing things, of seeing myself and others, and of interacting with the world.

Did you seek any type of emotional support?

Initially, the support came from my closest AA friend and others I met in the rooms of AA, people I would talk to on a one-to-one basis at meetings. I also stayed in touch with my oldest friend, the one who had told me perhaps I couldn't drink anything at all. Additionally, after just a few months of sobriety, I got involved with a girl I knew from high school and had become reacquainted with at the end of my drinking. She was not in AA—in fact she was still drinking, and ultimately came into AA herself after we ended our relationship. While it was not necessarily an "advisable" relationship for someone so new to sobriety, I don't know if I would have been able to maintain my sobriety without her. I needed someone to talk to, to care for, to connect with, and she was very important to me in the first year of my sobriety.

It took me longer to reach out to my family, even though my mother was also in recovery. She was someone I could talk to about recovery, to a degree, and could reach out to for emotional support. The rest of my family was less aware of my circumstances and less involved in my life.

Does the alcoholism have an impact on your family?

I come from a family that alcoholism had already had an impact on—my grandmother on my father's side was an alcoholic, as was my mother. Alcohol played a major role in the formative events of my life, and ultimately, it was no surprise that I turned to alcohol myself. My grandmother died when I was in my early teens, ostensibly of heart trouble, but clearly alcohol played a part in her death. She had been very domineering of my father, her only child, and helped set up patterns in his life that allowed him to enable my mother's alcoholism and the destruction that eventually wrought on the family. My mother's drinking escalated over time, following a progression that eventually left her hospitalized and institutionalized a number of times. Based primarily on my mother's drinking, its negative consequences, and my father's inability to recognize and acknowledge her active alcoholism, the family disintegrated after about twenty years of marriage. As the family fell apart my own drinking increased and I drifted further and further away from anything that was familiar in my life. I felt like a tumbleweed being blown across the desert floor, wandering aimlessly wherever the wind blew.

Many years later, once I had acknowledged my own alcoholism and had gained some measure of sobriety, I began to reconstruct some of the family relationships, or at least tried to. This has been an ongoing part of my sobriety, and after 23 years without a drink, and the formulation and creation of my own family—a wife and three daughters—I feel that I have made some headway in breaking the cycle of familial alcoholism. My brother and sisters have seen me grow and remain sober and I think it has provided for them an example of stability and perseverance. My mother died a little over a year ago, after almost 24 years of sobriety. She had gotten sober about six months before I did and eventually went on to become an alcoholism counselor. She was plagued, however, by poor health and lots of medical problems in her last ten years, and died in the hospital under difficult circumstances.

In my own life, I married a woman I met in AA, and the two of us have stayed sober and have remained active in AA. Our three children have never seen either of us drunk (a true blessing), and grew up in and around our community of recovering alcoholics. The two eldest ones (18 and 16 years old) have experimented with alcohol and drugs, but do not exhibit signs of unhealthy dependence. The youngest is 10 years old and has a pretty sophisticated world-view and a mature understanding of alcoholism.

What advice would you give to anyone living with alcoholism?

There are two aspects of alcoholism—living with it in yourself and living with it in someone else. Both aspects need examination. I grew up in an alcoholic household, but never thought that had any impact on myself or my siblings. Well, I was wrong. Subsequently, when I developed alcoholism myself, I thought I was only hurting myself, that I didn't have an impact on anybody else. Again, I was wrong.

Alcoholism causes pain—emotional, physical, and spiritual pain. It is pain that is largely avoidable. It is pain that is largely self-induced.

In the years I have been sober, I have come to understand that the world is full of pain—things happen, people die, tragedies unfold. It is also full of wonder and love. Today, the idea of bringing on more pain in my life—beyond the pain that will be there inevitably anyway—is totally abhorrent to me. I know that picking up a drink will not make anything in my life better. It will only make things worse.

So, if you are caught up in the pain of alcoholism, my only advice would be to surrender, to give up, to admit complete defeat and begin the process of rebuilding your life sober, without active alcoholism at the center. And, if you are living with or love an alcoholic, my advice would be to reach out for help—either in gaining information about the disease of alcoholism and its impact on the family, or getting psychological or emotional help. Honesty is a great antidote to alcoholism, and looking squarely at your situation can be a good beginning toward sobriety and a happy and purposeful life.

*Not his real name

Interviews were conducted in the past and may not reflect current standards and practices in medicine. Talk to your doctor to learn more about how this condition is diagnosed and managed today and what treatment approaches are right for you.

Alcoholism tends to run in families, and genetic factors partially explain this pattern. It is impossible to reduce your genetic risk. However, risk is not destiny. Certain factors, like strong social support systems , can help protect even high-risk people from becoming alcohol dependent. Other suggestions include:

Socialize without alcohol.

Avoid going to bars.

Do not keep alcohol in your home.

Avoid situations and people that encourage drinking.

Make new nondrinking friends.

Do fun things that do not involve alcohol.

Avoid reaching for a drink when stressed or upset.

Drink slowly.

Replace a drink with something else you really enjoy

Limit your alcohol intake to a moderate level.

Moderate is two or fewer drinks per day for men and one or fewer drinks per day for women and older adults.

A 12-ounce bottle of beer, a five-ounce glass of wine, or 1.5 ounces of liquor is considered one drink.

Description of Services Provided:Al-Anon provides support to families and friends of alcoholics, as well as help for teens. You will find information on the 12-step program, meetings, and resources, including newsletters and a magazine.

Description of Services Provided:AA provides information for adults and teens on alcoholism, self-assessment, the 12-step program, meetings, policies, contacts in the US and Canada, membership, real-life stories, and a history of AA.

Description of Services Provided:Moderation Management (MM) is a behavioral change program and national support group network for people concerned about their drinking and who desire to make positive lifestyle changes. MM empowers individuals to accept personal responsibility for choosing and maintaining their own path, whether moderation or abstinence.

Description of Services Provided:NIAAA provides a variety of resources for consumers and professionals about alcohol, including brochures, FAQs, news releases, and a web site for young teens. You will also find alcohol prevention information, databases, related organizations, research, conferences, and events.

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

A risk factor is anything that increases your likelihood of getting a disease or condition.

It is possible to develop alcoholism with or without the risk factors listed below. However, the more risk factors you have, the greater your likelihood of developing alcoholism. If you have a number of risk factors, ask your doctor what you can do to reduce your risk.

The following factors can increase your risk of alcoholism:

Gender

Alcohol abuse is five times more frequent in men than in women. Men are more likely to be binge drinkers and alcoholics than women. However, the incidence of alcoholism in women has been on the rise in the past 30 years. Women tend to become alcoholics later in life than men, but the condition has a faster progression in women.

Family History

Alcoholism tends to run in families. This has led researchers to conclude that a genetic predisposition to developing alcohol abuse problems may exist. The rate of alcoholism in men with no alcoholic parents is approximately 11%. For men with one alcoholic parent, the rate of alcoholism is approximately 30%. A family history of alcoholism is also seen in women, although the link is somewhat weaker.

Genetic factors

Some studies suggest that genetic factors affecting the way people’s bodies process and respond to alcohol may also influence an individual’s risk of becoming an alcoholic.

Cultural Factors

Alcoholism is clearly more of a problem in some cultures than in others. For example, rates of alcoholism are high in Europe and the United States where alcohol consumption is common and socially acceptable. In American culture, alcohol is often used as a social lubricant and a means of reducing tension. In religious groups, such as Mormons or Muslims who abstain from drinking alcohol, the incidence of alcoholism is minimal. Higher rates of alcohol abuse and alcoholism are also related to peer pressure and easy access to alcohol.

Psychological Vulnerability

Researchers have found that certain psychological factors increase an individual’s risk for alcohol abuse and alcoholism. These factors include having high self-expectations, having a low frustration tolerance, feeling inadequate and unsure of one's roles, needing an inordinate amount of praise and reassurance, and having a tendency to be impulsive and aggressive.

The purpose of screening is early diagnosis and treatment. Screening tests are usually administered to people without current symptoms, but who may be at high risk for certain diseases or conditions

Screening Guidelines

Screening tests for alcohol abuse and alcoholism usually involve simple questionnaires, either verbally administered by a doctor or given in written form. Several of the most commonly tests include the CAGE, the Michigan Alcoholism Screening Test (MAST), Self-Administered Alcoholism Screening Test (SAAST), The Alcohol Dependence Scale (ADS), the Alcohol Use Disorders Identification Test (AUDIT), and the T-ACE Test.

Some healthcare providers use a single question for screening: "When was the last time you had more than five drinks (for men) or four drinks (for women) in one day?" About 50% of all individuals who have a problem with drinking alcohol will answer "within three months" to this question.

Denial that an alcohol problem exists is common. Alcoholism is characterized by an extremely strong craving for alcohol, a loss of control over drinking, or a physical dependence on alcohol. In contrast, alcohol abuse is defined as a pattern of drinking that results in one or more of the following situations within a 12-month period:

Repeated problems at work, school, or home due to drinking

Risking physical safety by drinking in situations that are dangerous, such as driving or operating machinery

Recurring trouble with the law, such as being arrested for driving under the influence of alcohol or for physically hurting someone while drunk

Continuing to drink despite alcohol-related difficulties

Alcohol abuse often progresses to alcohol dependence or alcoholism. Alcoholism involves a powerful “craving,” or uncontrollable need for alcohol. This craving overrides the ability to stop drinking. This need can be as strong as the need for food or water. Symptoms of alcohol dependence include:

You have a unique medical history. Therefore, it is essential to talk with your doctor about your personal risk factors and/or experience with alcohol. By talking openly and regularly with your doctor, you can take an active role in your care.

General Tips for Gathering Information

Here are some tips that will make it easier for you to talk to your doctor:

Bring someone else with you. It helps to have another person hear what is said and think of questions to ask.

Write out your questions ahead of time, so you don't forget them.

Write down the answers you get, and make sure you understand what you are hearing. Ask for clarification, if necessary.

Don't be afraid to ask your questions or ask where you can find more information about what you are discussing. You have a right to know.

Specific Questions to Ask Your Doctor

About Alcohol Abuse and Alcoholism

Do you think I have an alcohol abuse problem?

Have you helped patients with alcohol abuse problems?

Where can I get help for an alcohol abuse problem?

I’m concerned that I’ve done damage to my body as a result of alcohol abuse. Can I have a physical exam and some tests?

About Your Risk of Developing Complications of Alcohol Abuse

Would my health problem(s) have anything to do with abusing alcohol?

If I continue with my current drinking pattern, am I putting myself at risk for complications?

About Treatment Options

What medical and nonmedical treatments are available for alcohol abuse and alcoholism?

What are the benefits, risks, and side effects of medical treatments for alcohol abuse and alcoholism?

How do the treatments work and how long will they take?

Can you refer me to a group for people with alcohol abuse problems?

Can you refer me to a mental health professional who specializes in the treatment of alcohol abuse and alcoholism?

If you find a mental health professional who specializes in the treatment of alcohol abuse or alcoholism, ask the following questions:

What type of training and how much experience do you have in treating alcohol abuse and alcoholism?

What is your basic approach to treatment?

How long will treatments last?

How long and frequent are the treatment sessions?

Do you accept health insurance?

Do you have fee schedules and sliding scale fees to accommodate various financial circumstances?

About Lifestyle Changes

What changes can I make to reduce my use of alcohol?

Is there anything I can do to enhance my recovery?

Is there anything I can do to reverse any damage I may have done to my body as a result of abusing alcohol?

About Outlook

What are my chances of successful recovery?

What if I relapse?

What are my chances of reversing any damage I may have done to my body as a result of abusing alcohol?

The type of treatment you receive depends on the severity of your alcoholism and the resources that are available in your community. Treatment may be on an inpatient or outpatient basis and may include:

Detoxification (the process of safely getting alcohol out of your system)

Prescribed medications to help prevent a return (or relapse) to drinking once drinking has stopped

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY.
Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.